Percutaneous alcohol injection under sonographic guidance in Morton’s neuroma: follow-up in 220 treated lesions

2016 ◽  
Vol 121 (7) ◽  
pp. 597-604 ◽  
Author(s):  
Luciano Perini ◽  
Claudia Perini ◽  
Matteo Tagliapietra ◽  
Davide Varotto ◽  
Andrea Valcarenghi ◽  
...  
Keyword(s):  
Morton’S Neuroma ◽  
Alcohol Injection ◽  
Sonographic Guidance ◽  
Morton's Neuroma

Treatment of Morton's Neuroma with Alcohol Injection Under Sonographic Guidance: Follow-Up of 101 Cases

2007 ◽  
Vol 188 (6) ◽  
pp. 1535-1539 ◽  
Author(s):  
Richard J. Hughes ◽  
Kaline Ali ◽  
Hugh Jones ◽  
Sue Kendall ◽  
David A. Connell
Keyword(s):  
Morton’S Neuroma ◽  
Alcohol Injection ◽  
Sonographic Guidance ◽  
Morton's Neuroma

scholarly journals Patient Related Outcome Measures (PROMs) in Morton’s Neuroma: Conservative vs. Surgical Management at One-Year Follow-Up

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0002
Author(s):  
Alastair Faulkner ◽  
Alistair Mayne ◽  
Fraser Harrold
Keyword(s):  
Outcome Measures ◽  
Surgical Management ◽  
Conservative Management ◽  
Morton’S Neuroma ◽  
Significant Difference ◽  
Morton's Neuroma ◽  
One Year ◽  
Patient Related Outcome ◽  
Eq Vas

Category: Midfoot/Forefoot Introduction/Purpose: Morton’s neuroma is a common condition affecting the foot and is associated with chronic pain and disability. Conservative management including a combination of orthotic input; injection or physiotherapy, and surgical excision are current treatment options. There is a paucity of literature regarding patient related outcome measures (PROMs) data in patients managed conservatively. We sought to compare conservative with surgical management of Morton’s neuroma using PROMs data in patients with follow-up to one year. Methods: Prospective data collection commenced from April 2016. Patients included had to have a confirmed Morton’s neuroma on ultrasound scan. Patient demographics including age, sex and BMI were collected. The primary outcome measures were the Manchester Foot Score for pain (MOX-FQ), EQ time trade off (TTO) and EQ visual analogue scale (VAS) taken pre-operatively; at 26-weeks and at 52-weeks post-operatively. Results: 194 patients were included overall: 79 patients were conservatively managed and 115 surgically managed. 19 patients were converted from conservative to surgical management. MOX-FQ pain scores: pre-op conservative 52.15, surgical 61.56 (p=0.009), 6-months conservative 25.1, surgical 25.39 (p=0.810), 12 months conservative 18.54, surgical 20.52 (p=0.482) EQ-TTO scores: pre-op conservative 0.47, surgical 0.51 (p=0.814), 6-months conservative 0.41, surgical 0.49 (p=0.261), 12 months conservative 0.26, surgical 0.37 (p=0.047) EQ-VAS scores: pre-op conservative 63.84, surgical 71.03 (p=0.172), 6-months conservative 46.10, surgical 52.51 (p=0.337), 12 months conservative 30.77, surgical 37.58 (p=0.227) Satisfaction at 12 months: conservative 17 (21.5%), surgical 32 (27.8%) p=0.327 Conclusion: This is one of the first studies investigating long-term PROMs specifically in conservative management for Morton’s neuroma patients. There was no significant difference in pain score and EQ-VAS between all conservative treatments and surgical management at 12 months There was no significant difference in satisfaction at 12 months between conservative and surgical groups.

scholarly journals Isolated Intermetatarsal Ligament Release as Primary Surgical Management for Morton’s Neuroma

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0013
Author(s):  
Mohamed Abdelaziz ◽  
Kathryn Whitelaw ◽  
Gregory Waryasz ◽  
Daniel Guss ◽  
Anne Johnson ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Nerve Transection ◽  
Digital Nerve ◽  
Morton’S Neuroma ◽  
The Past ◽  
Symptom Exacerbation ◽  
Morton's Neuroma ◽  
Web Space ◽  
Neuroma Formation

Category: Midfoot/Forefoot Introduction/Purpose: While the precise pathoetiology of Morton’s neuroma remains unclear, nerve inflammation as a result of chronic entrapment from the overlying intermetatarsal ligament (IML) may play a role. Traditional surgical management involved common digital nerve transection with neuroma excision, but this procedure risks unpredictable formation of a stump neuroma and potential worsening of symptoms. Accordingly, the senior author has over the past six years espoused isolated IML release and common digital nerve decompression in lieu of nerve transection or neuroma excision as an alternative treatment strategy. We hypothesized that IML release offers effective pain relief and high patient satisfaction level as a surgical treatment for recalcitrant Morton’s neuroma without the risk of stump neuroma formation or symptom exacerbation. Methods: Medical records for all consecutive patients treated surgically with isolated single interspace IML release for symptomatic and recalcitrant Morton’s neuroma over a four year period at a large academic medical center were examined. Any adult patient with clinically diagnosed Morton’s neuroma who had failed at least three months of conservative treatment and who then underwent single-webspace IML decompression were included. Any patient who had less than three months postoperative follow up, had undergone revisional neuroma surgery, or had undergone additional procedures at the time of the IML release were excluded. Overall patient satisfaction as well as pre- and post-operative Visual Analog Pain Scale (VAS) assessments were recorded for all patients. Results: Eleven patients underwent isolated, single interspace IML decompression for Morton’s neuroma over this time frame. One of these patients had a neuroma localized to the second web space and 10 were localized to the third web space. Average follow-up was 10.8± 9 (3-32) months (Table 1). VAS pain scores averaged 6.4 ± 1.9 (4-9) preoperatively and decreased to an average of 1.5 ± 1.6 (0-5) at final follow up (P = 0.003). All patients reported significant pain improvement and an overall satisfaction with the procedure (would undergo it again). No patients returned to the operating room, there were no postoperative infection nor worsening of pain, and no other complications were reported. Conclusion: Isolated single interspace IML release of chronically symptomatic Morton’s neuroma shows promising short-term results regarding pain relief and overall patient satisfaction, with few complications and no demonstrated risk of recurrent neuroma formation, permanent numbness, or postoperative symptom exacerbation. The authors’ collective experience with this approach has been positive enough over the past six years to result in the entire abandonment of the practice of neuroma excision in this patient population.

Patient-Related Outcome Measures (PROMs) With Nonoperative and Operative Management of Morton’s Neuroma

2020 ◽  
pp. 107110072096106
Author(s):  
Alastair Faulkner ◽  
Alistair Mayne ◽  
Peter Davies ◽  
David Ridley ◽  
Fraser Harrold
Keyword(s):  
Outcome Measures ◽  
Operative Management ◽  
Symptom Improvement ◽  
Morton’S Neuroma ◽  
Level Of Evidence ◽  
Morton's Neuroma ◽  
Patient Related Outcome ◽  
New Diagnosis ◽  
Eq Vas

Background: Morton’s neuroma is associated with chronic pain and disability. There is a paucity of literature regarding patient-related outcome measures (PROMs) in patients managed nonoperatively. We sought to investigate nonoperative and operative management of Morton’s neuroma using PROMs in patients with follow-up to 1 year. Methods: We conducted a prospective observational study and collected data on all patients with a new diagnosis of Morton’s neuroma treated from February 2016 until April 2018. Primary outcome measures were the Manchester-Oxford Foot Questionnaire (MOXFQ) for pain, EuroQoL (EQ) time trade-off (TTO), and EQ visual analog scale (VAS) taken preoperatively and at 52 weeks postoperatively. Forty-four patients were treated nonoperatively and 94 patients were treated operatively. Results: Pretreatment and 52-week scores were 55.7 and 43.10 (nonoperative) and 63.7 and 40.1 (operative) for MOXFQ (pain), 0.72 and 0.82 (nonoperative) and 0.68 and 0.82 (operative) for EQ-TTO, and 71.5 and 76.2 (nonoperative) and 73.1 and 68.7 (operative) for EQ-VAS. There was a statistically significant improvement in MOXFQ (pain) in nonoperative ( P = .02) and operative groups ( P < .001). There was a statistically significant improvement in EQ-TTO in the operative group only ( P = .01). Conclusion: This is the largest study investigating outcomes to 12 months of both nonoperative and operatively managed patients with Morton’s neuroma. Both nonoperative and operative management lead to symptom improvement at 12 months. Level of Evidence: Level III, comparative study.

scholarly journals Effects of Alcohol Injection in Rat Sciatic Nerve as a Model for Morton’s Neuroma Treatment

2014 ◽  
Vol 35 (11) ◽  
pp. 1187-1191 ◽  
Author(s):  
Mathew J. Mazoch ◽  
Gulraiz A. Cheema ◽  
Larry J. Suva ◽  
Ruth L. Thomas
Keyword(s):  
Sciatic Nerve ◽  
Morton’S Neuroma ◽  
Alcohol Injection ◽  
Rat Sciatic Nerve ◽  
Morton's Neuroma

TRUE EPINEURAL NEUROLYSIS IN MORTON'S NEUROMA: A 5-YEAR FOLLOW UP

Orthopedics ◽  
1996 ◽  
Vol 19 (5) ◽  
pp. 397-400
Author(s):  
P F Diebold ◽  
B Daum ◽  
V Dang-Vu ◽  
M Litchinko
Keyword(s):  
Morton’S Neuroma ◽  
Morton's Neuroma

Ultrasound Guided Alcohol Ablation of Morton's Neuroma

2012 ◽  
Vol 33 (3) ◽  
pp. 196-201 ◽  
Author(s):  
Rachel E. Musson ◽  
Jasdev S. Sawhney ◽  
Leslie Lamb ◽  
Antony Wilkinson ◽  
Haron Obaid
Keyword(s):  
Case Series ◽  
Visual Analogue Score ◽  
Safe Procedure ◽  
Ultrasound Guided ◽  
Morton’S Neuroma ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Alcohol Injection ◽  
Alcohol Ablation ◽  
Morton's Neuroma

Background: Morton's neuroma is a common cause of metatarsalgia. This study evaluated the efficacy of ultrasound guided alcohol injection as a treatment for this condition. Method: Data from 87 treatment courses were included in this study with a mean follow of 14.3 months. Results: Technical success was 100%. One patient developed symptoms consistent with an allergic reaction to the injection and one patient declined further injection because of periprocedural pain. Partial or total treatment response was achieved in 66%, with 32% of patients having complete resolution of pain. The median visual analogue score (VAS) decreased from 8 pre-procedure to 4 post-procedure ( p < 0.0001). Procedural success was greater in patients under 55 years old and in those with solitary neuromas. Seventeen patients (20%) went on to have surgery due to continuing pain. Conclusion: Ultrasound guided alcohol ablation for the treatment of Morton's neuroma was a safe procedure that significantly reduced pain and may offer an alternative therapy to surgery. Level of Evidence: IV; Retrospective Case Series

Efficacy of Chemical Neurolysis for the Treatment of Interdigital Nerve Compression of the Foot

2007 ◽  
Vol 97 (3) ◽  
pp. 203-206 ◽  
Author(s):  
John D. Mozena ◽  
Jared T. Clifford
Keyword(s):  
Cohort Study ◽  
Treatment Option ◽  
Study Data ◽  
Nerve Compression ◽  
Treatment Center ◽  
Morton’S Neuroma ◽  
Effective Treatment Option ◽  
Alcohol Injection ◽  
Historical Cohort ◽  
Morton's Neuroma

Background: Dilute alcohol injection has been described as a nonsurgical treatment option for interdigital nerve compression of the foot, also known as “Morton’s neuroma.” This study reviews the efficacy of the procedure in 49 feet at one treatment center. Methods: In this historical cohort study, data from 42 patients who had undergone alcohol injection therapy were obtained from clinic records. A total of 49 feet were reviewed. Results: Symptoms were improved or resolved in 30 (61%) of 49 feet. Nineteen feet (39%) were unimproved, with 12 of those progressing to surgical neurectomy. Feet that received five or more injections were more likely to improve (74%) than those that received fewer than five injections (39%). Three patients reported mild complications associated with dilute alcohol injection, all of which resolved spontaneously within 2 days of the injection. Conclusions: Dilute alcohol injection is a safe and effective treatment option for patients with Morton’s neuroma who want to avoid a surgical procedure and any associated complications. The procedure may be more successful if the patient receives at least five injections. (J Am Podiatr Med Assoc 97(3): 203–206, 2007)

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